Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | AL |
NPI | 1467515627 |
---|---|
Provider Name | Mrs. Barbara Ann Clinton |
First Address | Bessemer, AL 35020-8600 |
Second Address | Bessemer, AL 35020-8600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
51057240 | BLUE CROSS BLUE SHIELD (01) | AL |